No Valley Without Shadows

Médecines Sans Frontières- Doctors Without Borders South Africa (MSF) launched a book titled, No Valley Without Shadows, at the Book Lounge in Cape Town depicting the reality of the struggle to provide antiretrovirals (ARVs) to the marginalised in South Africa, and the unwavering force the Treatment Action Campaign (TAC), who continue to act as an agent of change, despite its financial crisis.

The MSF book, No Valley Without Shadows.
The MSF book, No Valley Without Shadows. Photographed by Megan Harker Elliott.

On the eve of World AIDS day, cries rang out resounding in the Book Lounge,

“Amandla! Awethu!” from the mouths of doctors, activists, researchers, academics and TAC comrades. The launch is a commemoration, a moment taken, to pause, reflect, and unite in solidarity to propel toward a revived struggle to provide ARV treatment to all who need it in South Africa.

Dr Eric Goemaere from MSF, with renowned author Liz McGregor, joined TAC’s Andile Madondile in a panel discussion to contemplate testimonies from the AIDS denialism period in South Africa, to the leap from zero to 3 million people on ARV treatment in 2015, to the big pharma court cases and Nelson Mandela’s show of solidarity when wearing an HIV-positive t-shirt in place of his bespoke shirt.

Panellists spoke from a place of authenticity of their experience as witnesses to the South African struggle encompassing HIV, AIDS, the ARV struggle, and listened with humility and respect to each other’s accounts.

Madondile spoke of research he had done to supplement his knowledge on advanced medications available in developing countries. “It will take 20 years before we have it in South Africa because if we don’t toyi- toyi, we don’t challenge the government and we won’t get what we want,” says Madondile.

“I don’t know if these strategies- 90-90-90 targets are going to work. Our public hospitals are overcrowded as we speak. The idea of MSF taking clients and treatment out of clinics. I don’t know if It is going to work but it’s going to be difficult because we need more doctors, and nurses,” says the activist.

MSF and TAC were lauded by Madondile for their contributions to the struggle for ARVs and treatment literacy that helped expunge the theory among communities that if you had HIV you were bewitched.

McGregor moved from Britain, back to South Africa in 2002 and although there was interest in Europe about HIV and AIDS, “I found HIV and AIDS totally invisible in South Africa,” says the author.

McGregor’s observations and experiences were compounded: first, in the rural hills of KwaZulu-Natal (KZN) witnessing women suffering a slow, painful death, emaciated with their only recourse being plasters, painkillers and bandages.

Post the KZN experience, the author was asked to document the experience of iconic YFM DJ, Khabzela Khaba which entailed observing Khaba’s HIV and AIDS treatment regimen of fruit, vegetable and multivitamin smoothies fed to him, by his Dutch nurse, personally arranged by Manto Shabala Msimang.

In a quest to understand why Khaba made the decisions that he did, McGregor discovered a pathology of social determinants associated with his death; the poverty, inequality, psychological wounds of apartheid, lack of trust in the medical system, the way he grew up, the kind of fragile masculinity he absorbed where black men were marginalised, and made to seem dangerous and expendable. At this point, McGregor’s experiences culminates into salient awareness of TAC’s work.

“At first, I have to say, I was anxious about the work of TAC because the government was our government. We’d worked really hard to get the ANC in power so to have this civil society movement who criticised the government was a little bit uncomfortable but anyway, as I got to know more TAC people and worked with them. I just became hugely impressed with them. They understood the type of stuff Khaba was dealing with-the sort of, cultural matrix.”

Goemaere, Medical Doctor, honorary UCT lecturer and MSF HIV and TB Coordinator, reflected on the days of ARV selection committees, taking the audience back to when it was the job of doctors and nurses such as Sis’ Nompumelelo Matangana to make life or death decisions about who received ARVs and who not.

“We would select one out of three or four for treatment, the others would be condemned to death. This is where we come from- never forget this. It has been a long way to get out of this.”

Goemaere reflects on landmark court cases against big pharma and how Madiba was roped in to help. The book explains it all.

The MD brings us back to the future. “People say three million people are on treatment-we need to double it to six million.” “We do not have enough human resources and physical space in our clinics to accommodate all these people.”

Matangana recounts how Goemaere was threatened and harassed by political figures to leave the country if specific clinics went up. “Eric are you going to leave? Because that clinic is going up tomorrow,” Sis’ Phumi remembers, telling Goemaere while they share a giggle across the room.

Audience members posed questions to the panel about stigma that still persists in communities and how to translate research into action on the ground. Social activist Fatima Hassan, gave special acknowledgement to Eric, Katherine and their family for the sacrifice and endurance of resistance on issues such as but not limited to politics and economics to help provide and increase the provision of ARVs for people living with HIV in South Africa.

The Chief Operational Executive of TAC, Helen Chorlton was in the audience. “We’ve had to downsize our employees- 40% won’t be coming back to work in January,” says Chorlton, in a call for funding from anyone who could help contribute.

The Book Lounge, which celebrates its birthday on World AIDS day, and MSF took no commission or proceeds for the book, gifting all sales of the book to TAC.

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